A week in my ... child psychology clinic

Peadar Maxwell is senior child psychologist for the HSE in Wexford

Peadar Maxwell is a  senior psychologist within the HSE in Wexford. Photograph: Patrick Browne

Peadar Maxwell is a senior psychologist within the HSE in Wexford. Photograph: Patrick Browne

 

I am the senior psychologist in a primary care child and adolescent psychology team within the Health Service Executive in Wexford. We assess and treat children aged up to 18 years from rural and urban Wexford for a host of difficulties.

I work in the local community dealing with a variety of different conditions and situations.

Some clinicians find the role too broad and all-encompassing, but that’s precisely what motivates me. I could be assessing a communications disorder one day and screening for autism or anxiety the next.

A psychologist in the community is expected to know about neuro-developmental disorders, bereavement and loss, emotional difficulties and child welfare – all of which are specialist areas in societies with more psychology resources available to the public.

Another big part of my job is keeping up on the latest research and new knowledge and I am bit of a junkie in that regard. I enjoy reading up on research which is happening at universities around the world.

For the past 20 years, psychology, and especially developmental psychology, was getting closer to biology. That seems to have transformed now into how psychologists can use the new scientific knowledge without forgetting how important something as basic as the relationship is.

I love and am intrigued by brain science but I still firmly believe in the power and art of the relationship.

Pacing myself

I am an early riser and enjoy breakfast and pacing myself in the morning. If possible, I practice Feldenkrais most mornings. It is a form of body awareness that helps me relax and sets me up for the day. Then there’s the usual caring for the dog and helping to get the kids out to school, along with my wife, Maryjo.

Technically we are expected to work from 9am to 5pm each day, but it is not that rigid. Often we are in early and out late – appointments need to suit parents’ work schedules and many of the teenage clients are in exam years at school and require flexibility. So we have a very flexible approach to accommodating families and their needs.

I value my lunch breaks and never eat at my desk. I might walk home, which is a lucky situation to be in, to see my dog and eat lunch there, or I could meet a friend for a bite to eat and a chat. Most of my working days are spent in the clinic, with school visits and the occasional home visit as well.

Typical examples of referral concerns might include children with anxiety which is interfering with their overall wellbeing and participation in school and social activities. But it could be everything from bedwetting or hyperactivity to a query about autism or even dealing with a loss in the family.

Our department offers a prompt initial assessment but sometimes we are not the right service for a particular child, so a referral onwards or liaising with the GP may be the next intervention.

Providing education is also an important aspect of a psychology practice. Psychologists aim to bring psychology and its knowledge base to others in the community. So I provide training to my co-professionals such as speech and language therapists, occupational therapists and public health nurses, as well as staff from the Child and Family Agency (Tusla) across a range of topics including stress management, attachment theory and behavioural strategies.

Give talks

I also give talks in the community, generally to parents in local schools on issues that they feel are current in their school community. Primary care is about a balance between what is described as population health, getting out there and informing people about topics, and assessing and responding to referral concerns.

Most referrals come from GPs, paediatricians and other HSE and Tusla professionals. Liaising with other disciplines offers an opportunity to explain what psychology can provide to others and to learn about what other disciplines are doing for a child and family.

The best part of my job is seeing progress. Very often the psychologist is not there to witness the progress as it may happen in school, at home or later in life, but occasionally something like a school-phobic child returning to school or parents adjusting a harsh parenting style can be proof that this does work.

I practise DDP which is a playful attachment-friendly therapy that particularly suits adopted children and children in care. It’s heartening to witness parents and children being playful together after a tough period.

On the other side of the coin, the most difficult issue to handle is non-engagement by families. We work very hard at this, but sometimes there is little we can do and we certainly cannot facilitate change when a family does not participate.

Waiting lists are the bugbear of most psychology services and it is very difficult to tell parents that their child may have to wait for appointments. We have a number of initiatives that help in this regard, but there will always be some children and families who have to wait longer than any psychologist would wish. We have a prompt initial assessment process, a kind of enhanced screening process if you like, and do brief interventions when possible to allow others the chance to access the service.

In Wexford, we created and piloted a parent drop-in service which has been evaluated and has evolved over the years to become a Parent Consultation Service to allow for easy access to a psychologist for parents and carers with concerns for a child. We were thrilled in 2008 when the Department of the Taoiseach awarded us an Excellence in Public Service award.

I am responsible for the supervision of other psychologists as well and am so incredibly lucky to be part of a highly motivated team of clinicians who are always trying to improve the service available to the public. Working in a community clinic means I work with a host of other disciplines and the varied staff at the clinic here is second-to-none in terms of professionalism and colleague support.

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